Improvements in living condition and advances in health care have resulted in a marked prolongation of life expectancy for elderly and disabled population. These individuals, a growing part of society, are dependent upon the delivery of home health and general care, which has its own set of challenges and drawbacks. This population needs continuous general, as well as medical, supervision and care. For example, supervision of daily activities such as dressing, personal hygiene, eating and safety as well as supervision of their health status is necessary. Furthermore, the relief of loneliness and anxiety is a major, yet unsolved, problem that has to be dealt with.
The creation of retirement facilities and old age homes, as well as other geriatric facilities, provides only a partial solution to the problems facing the geriatric population. As discussed in U.S. Pat. Nos. 5,544,649 and 6,433,690, the notion of ambulatory (home environment) patient care is gaining increased popularity and importance. As discussed in the '649 patent, the number of old aged people receiving home care services under Medicare has shown a 13% annual growth rate and has tripled in 10 years (1978-1988) from 769,000 to 2.59 million. This shift in patient care from the “sheltered” institutional milieu to the patient's home, work place, or recreational environment is driven in part by cost and in part to a new care concept that prefers keeping the aged and the disabled in their own natural environment for as long as possible.
Typically, home care is carried out either by the patient's family or by nonprofessional help. The monitoring equipment at home care facilities is usually minimal or nonexistent, and the patient has to be transported to the doctor's office or other diagnostic facility to allow proper evaluation and treatment. Patient follow-up is done by means of home visits of nurses which are of sporadic nature, time consuming and generally very expensive. A visiting nurse can perform about 5-6 home visits per day. The visits have to be short and can usually not be carried out on a daily basis. Moreover, a visiting nurse program provides no facilities for continuous monitoring of the patient and thus no care, except in fortuitous circumstances, in times of emergency. The remainder of day after the visiting nurse has left is often a period of isolation and loneliness for the elderly patient.
In outpatient care, health-threatening falls are an important epidemiological problem in this growing segment of the population. Studies indicate that approximately two thirds of accidents in people 65 years of age or older, and a large percentage of deaths from injuries, are due to falls. Approximately 1.6 million hip fracture injuries worldwide in 1990 were due to falls, and that this number will increase 6.26% by 2050, with the highest incidences recorded in Northern Europe and North America. In the elderly, 90% of hip fractures happen at age 70 and older, and 90% are due to falls. The falls are usually due (80%) to pathological balance and gait disorders and not to overwhelming external force (i.e., being pushed over by some force). More than 50% of elderly persons suffer from arthritis and/or orthopedic impairments, which frequently leads to falls. Specifically prone to falls are women experiencing a higher percentage of arthritis-related structural bone changes. It is estimated that approximately 5% of falls result in fracture and 1% of all falls are hip fractures. The percentages vary slightly in different geographical regions (e.g., Japan, Scandinavia), but the consensus of the available research is that the falls are a significant epidemiological problem in the growing elderly population.
The physiological and medical results of a fall range from grazes, cuts, sprains, bruising, fractures, broken bones, torn ligaments, permanent injuries and death. The most common fall-related injuries are lacerations and fractures, the most common area of fracture being the hip and wrist. Damage to areas such as the hip and legs can result in permanent damage and increased likelihood or further falls and injuries.
Falls in the elderly can produce social and mental as well as physiological repercussions. Anguish and reduced confidence in mobility can complicate problems and even increase the probability of falls and severity of fall-related injuries from lack of exercise and tensing of muscles.
Among older people in the U.S. (age 65+) there are approximately 750,000 falls per year requiring hospitalization due to either bone fracturing (approx. 480,000 cases) or hip fracturing (approx. 270,000 cases). The result of such injuries is an average hospital stay between 2 and 8 days. Assuming the average cost of $1,000 per hospital day, a total cost of falls in the elderly for the health care industry can be estimated at three billion dollars per year. This figure is likely to increase as the older age segment of the population increases.